Development of an expert-based training tool for decision making in laparoscopic appendicectomy surgery

Abstract

With the evolution of surgical training in Australia, trainees have decreased exposure to expert-led operative teaching and decreased time to practice. In order to most effectively augment surgical training, by acknowledging that decision-making is what differentiates expert from novice operators, it becomes possible to develop expertise-led training materials. By identifying the domains in which experts and novices perform differently, namely, judgement and decision making during difficult moves, and utilising cognitive interview techniques to extract this information from surgical subject matter experts, additional resources that can support the teaching of operative decision-making may be developed to improve the operative learning curve. Laparoscopic appendicectomy is the most commonly performed emergency laparoscopic surgical operation and is often performed by surgeons in training. Utilising this operation as a framework, two expert surgeons with teaching experience were interviewed using a cognitive task analysis interview technique to elicit detailed operative decision-making points. These interviews then underwent qualitative analysis and the results presented to a second panel of expert surgeons for Delphi review until consensus was reached regarding the information about decision making in laparoscopic appendicectomy surgery. The result of this study is a detailed, consensus-based, super expert approach to decision making in laparoscopic appendicectomy surgery than can be plainly taught to surgeons in training. Four main themes, or types of information, were elicited which were summarised in 27 sections. Assessment of the operative findings, detailed descriptions of critical operative steps, operative technique or heuristics, and details about specific situations that may be encountered. Presented in chronological order, this detailed description of operative performance is easily understood and presents information previously learnt only through observation, direct coaching or trial by error learning, in a novel format in a way that can significantly increase understanding. Using additional novel resources to augment the teaching of operative decision making has the potential to improve the operative learning curve, performance, and ultimately patient outcomes. While this information has been presented as a text-based document, combined with operative videos it has great potential to be a widely accessible and valuable learning resource.

Date of Award	2021
Original language	English